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Treatment

Examples of several of the most commonly used treatments are provided in the table below. As always, treatment decisions should be individualized.

Drug*

Dosage regimen for adults

Iodoquinol

650 mg orally three times daily for 20 days

OR

Paromomycin

25–35 mg per kg per day orally, in three divided doses, for 7 days

OR

Metronidazole**

500–750 mg orally three times daily for 10 days

*Not FDA-approved for this indication.

** Metronidazole is a nitroimidazole drug. The nitroimidazole drugs secnidazole and ornidazole have been used to treat D. fragilis infection but are unavailable in the United States.

Iodoquinol

Iodoquinol is available for human use in the United States.

Note on Treatment in Pregnancy

Oral iodoquinol has not been assigned a pregnancy category by the Food and Drug Administration. Data on the use of iodoquinol in pregnant women are limited, and risk to the embryo-fetus is unknown. Iodoquinol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Note on Treatment During Lactation

It is not known whether iodoquinol is excreted in breast milk. Iodoquinol should be used with caution in breastfeeding women.

Note on Treatment in Pediatric Patients

The safety of iodoquinol in children has not been established.

Paromomycin (Oral)

Oral paromomycin is available for human use in the United States.

Note on Treatment in Pregnancy

Oral paromomycin has not been assigned to a pregnancy category by the Food and Drug Administration. Data on the use of oral paromomycin in pregnant women are limited, and the risk to the embryo-fetus probably is low. Oral paromomycin generally is poorly absorbed from the gastrointestinal tract, with minimal, if any, systemic availability.

Note on Treatment During Lactation

Oral paromomycin is unlikely to be excreted in breast milk, and the drug generally is poorly absorbed from the gastrointestinal tract.

Note on Treatment in Pediatric Patients

The safety of oral paromomycin in children has not been formally evaluated. However, the safety profiles likely are comparable in children and adults.

Metronidazole

Metronidazole is available for human use in the United States.

Note on Treatment in Pregnancy

Metronidazole is in pregnancy category B. Data on the use of metronidazole in pregnant women are conflicting. The available evidence suggests use during pregnancy has a low risk of congenital anomalies. Metronidazole may be used during pregnancy in those patients who will clearly benefit from the drug, although its use in the first trimester is generally not advised.

Pregnancy Category B: Either animal-reproduction studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester (and there is no evidence of a risk in later trimesters).

Note on Treatment During Lactation

Metronidazole is excreted in breast milk. The American Academy of Pediatrics classifies metronidazole as a drug for which the effect on nursing infants is unknown but may be of concern. The World Health Organization (WHO) advises to avoid metronidazole treatment in lactating women. Metronidazole should be used during lactation only if the potential benefit of therapy to the mother justifies the potential risk to the infant.

Note on Treatment in Pediatric Patients

The safety of metronidazole in children has not been established. Metronidazole is listed as an antiamebic and antigiardiasis medicine on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.